The debate on the ‘brain drain’, or the emigration of skilled workers, is not new but it has taken on greater urgency in the context of a globalizing economy and ageing societies. Today, the developed world is perceived as poaching the best and the brightest from the developing world, thus prejudicing those countries of their chance of development. This paper starts with two guarded caveats: first, that any brain drain is as much internal within any country as it is among countries and, second, that the skilled migration system should not be seen in isolation from other types of migration. The paper reviews the data available for the analysis of skilled migration and identifies the main global trends. It goes on to examine the globalization of education and of health as reflected in the movement of students and health personnel. Large numbers of people from developing countries are being trained overseas and, of those trained at home, many cannot be absorbed productively into their economies of origin. The paper examines the case for a two-tiered health training system, one for global markets and the other for local markets. Retention and return of the skilled are examined through the potential for outsourcing in both education and health care. However, the association between the presence or absence of health personnel and the health status of a population is seen as simplistic. The paper concludes with an examination of policy contradictions within the global system towards skilled migration and offers pointers towards a more integrated approach.
The increase in the numbers of international migrants over recent decades has been more than matched by the growth in research into issues surrounding these international population movements. Amidst the torrent of writing, two major issues appear to have emerged in the more applied or policy-relevant side of the debate: remittances (Maimbo and Ratha 2005) and the migration of the skilled (Commander, Kangasniemi and Winters 2002; Cornelius, Espenshade and Salehyan 2001; Findlay 2002; and Lowell, Findlay and Stewart 2004). This paper will focus on the second of the issues, skilled international migration. Human capital formation is considered to be of central importance to development and the ultimate reduction, even eradication, of poverty. Thus, any loss of the skilled through migration may be prejudicial to the achievement of development goals and any discussion of the movement of the skilled is inextricably bound up with what is generally referred to as the ‘brain drain’, a debate that has been ongoing for over four decades.
Originally, the discussion of a brain drain was framed in the United Kingdom in the context of the loss of British scientists and doctors across the Atlantic to the United States. However, it quickly came to be applied to the replacement migration of the skilled from former colonies to Britain and its impact on the developing countries of origin. This migration was usually seen in negative terms: that the exodus of the skilled deprived countries of origin of the human capital they needed in order to develop. Today, the debate has moved on and, generally, more guarded interpretations are put forward that the emigration of the skilled need not necessarily be negative for development. Nevertheless, despite suggestions that the impact of the outmigration of the skilled is more complex than might at first appear, a tendency still remains to view the exodus of the skilled from developing countries as negative, and stopping that migration, and the retention and return of the skilled, as positive (see, for example, Dia 2004 and Kupfer et al 2004). A research project funded by the United Kingdom government and the Trade Union Congress is mooted to recommend that academics in higher education in Africa should not be recruited into British universities (The Guardian, 28 May 2005). Such a strategy would extend an existing ethical code of practice of recruitment for health professionals to the education sector. At present, the British National Health Service has decided not to recruit actively from 154 countries and territories in the developing world and seeks to ensure that the recruitment agencies used to bring nurses and doctors to the United Kingdom adhere to established ethical guidelines (OECD 2004). Such programmes might appear to be morally impeccable to the extent that they attempt to protect the interests of origin states against those of destination states but they are difficult to implement (see, for example, Willetts and Martineau 2004). They also exclude certain individuals from opportunities which, if
implemented, could be seen to be discriminatory or even racist. The tension between individual rights and state interests is writ large.
The whole issue of the brain drain has taken on a greater significance in recent years in the context of the sustained and rapid decline in fertility in the countries of the developed world, including those in eastern Asia. Rapid rates of economic development based on high technology industrialization but declining rates of growth in the indigenous labour force fuel a demand for imported skilled labour. Thus, on the one hand, concern exists to limit the perceived damage of the exodus of the skilled on developing countries of origin, but on the other, the rising demand for skilled migrants in potential countries of destination creates policy dilemmas and contradictions. Thus, despite good intentions towards ethical recruitment from developing countries, virtually all potential destination countries either pursue, or take a positive view towards, the immigration, on a permanent or
temporary basis, of the skilled. Such an approach by developed countries is usually in stark contrast with their policies towards unskilled labour that is generally much more restrictive.
Within the debate on the brain drain three separate strands of research into the migration of the skilled can perhaps be identified: of scientific workers and particularly those in information technology (IT); of health workers; and a growing body of literature on the movement of students. This paper will attempt to cover these three sectors in an integrated way. The health sector in particular is often seen as ‘exceptional’ to the extent that the tensions between origin and destination are here arguably writ largest. The loss of key medical personnel is seen to deprive origin countries of access to a basic human right, that of adequate health care, while that care cannot be provided in destination countries without importing health personnel to meet the growing demand in ageing societies. Clearly, however, the education sector is also being drawn into this critical category and it is perhaps apposite now to attempt a reappraisal of a complex issue by examining possible common patterns among the movements of the skilled and linkages to other forms of mobility.
At the outset, it must be emphasized that virtually absent from the brain drain debate is any assessment of linkages to, or even the impact of, any internal brain drain, or of the impact of domestic migration, particularly rural-to-urban migration, on the development potential of the rural sector. As it is in the rural sector that the majority of the world's poor are still to be found, any examination of linkages between the movement of skilled people and poverty alleviation must ultimately focus on that sector. The loss of the most educated members of any village may undermine community-based organizations and erode that population's capacity to respond to development programmes implemented at the local level. Hence, in dealing with poverty
alleviation, it is the internal brain drain that is likely to be of more importance than the international movement of the skilled from the larger urban centres of a country. This statement must immediately be qualified by stressing that any consideration of internal movements will dilute the discussion of the movement of the ‘highly skilled’ simply because relatively few highly skilled
migrants either come from, or go to, the rural sector. Nevertheless, any development goal to create, retain or attract the skills necessary for the development of the rural sector remains one of the most intractable issues in developing countries today. Any discussion of migration and the highly skilled as it relates to poverty needs to consider impacts of domestic movements alongside
the more commonly examined international movements of the skilled.
A second and related dimension of the current debate that is problematic is that the movement of the skilled in itself tends to be seen as virtually making up a separate migration system. Linkages to unskilled groups are rarely considered. This paper argues that skilled migration cannot be seen in isolation and the movement of skilled people generates less-skilled jobs that may imply labour importation schemes. As suggested above, policies towards the more lowly skilled tend to be more restrictive than those aimed at the highly skilled. Thus, policies designed specifically to deal with the skilled may actually conflict with those designed to deal with other categories of migrants and a need for a more integrated approach clearly exists. Also, it can be questioned how skilled some of those classified as ‘skilled’ really are and many of those considered as ‘less skilled’ may actually be highly skilled, paradoxical though this might seem. Highly skilled tradesmen such as plumbers, carpenters or bricklayers, for example, would not fall into the category of the highly skilled, while university graduates with an Arts degree may have few marketable skills.